Notice of Action Documents

Note:  These Notices of Action documents, primarily for the use of the counties, are in Word format only.

• M16-105 (8/08) - EBT Expedited Availability
• M16-120A (6/11) - EBT Dormant Account
• M16-120B (6/11) - EBT Dormant Account: Suspend
• M16-120C (8/08) - EBT Dormant Account: Reactivate
• M16-215 (8/08) - EBT Availability
• M16-325A (7/02) - EBT Exemption Request
• M16-325B (8/08) - EBT Exemption: Need Additional Facts
• M16-325C (8/08) - EBT Exemption: Deny
• M16-325D (8/08) - EBT Exemption Ended
• M16-325E (8/08) - Direct Deposit Cancellation
• M16-505A (7/02) - Designated Alternate Cardholder
• M16-505B (8/08) - Designated Alternate Cardholder Request: Need Additional Facts
• M16-505D (8/08) - Designated Alternate Cardholder: Deny 
• M16-701 (8/08) - EBT Adjustment Advice
• M16-705 (6/23) - EBT Adjustment Denial 
• M20-003 (7/01) - Duplicate Aid Match, Discontinue
• M20-003A (7/01) - Duplicate Aid Match, Deny
• M20-353C (6/98) - Penalty Applied to AU, Fraud Penalty, Change
• M20-353D (6/98) - Penalty Applied to AU, Fraud Penalty, Approval
• M20-353E (6/98) - Penalty Applied to AU, Fraud Penalty, Other
• M20-353F (6/98) - Penalty Stops, Fraud Penalty, Change
• M40-105 (11/14) - Failed to Provide SSN When Received or Failure to Cooperate
• M40-105A (11/14) - Failed to provide SSN or proof of completed SSN Application
• M40-105B (7/98) - Immunizations, Required Documentation, Change
• M40-105C (11/14) - Notice Of Action - Immunizations
• M40-105D (7/98) - School Attendance, Required Documentation
• M40-105D1 (1/15) - Notice Of Action - School Attendance
• M40-105E (2/15) - Notice Of Action - School Attendance
• M40-105F (1/02) - Non-Cooperation of Added AU Member
• M40-105G (1/02) - Failure to Cooperate, Discontinue
• M40-105H (1/02) - Refusal to Cooperate, Discontinue
• M40-105I (3/00) - Failure to Cooperate, Deny
• M40-105J (3/00) - Refusal to Cooperate, Deny
• M40-107 (6/11) - Addendum 1 - Child Support Collection For CalWORKs 48-Month Time Limit Exemption - Use Until April 30, 2022
• M40-107 (4/21) - Addendum 1 - Child Support Collection For CalWORKs 60-Month Time Limit Exemption - Use Starting May 1, 2022
• M40-107 (6/11) - Addendum 2 - Child Support Collection For CalWORKs 48-Month Time Limit Exemption - Use Until April 30, 2022
• M40-107 (4/21) - Addendum 2 - Child Support Collection For CalWORKs 60-Month Time Limit Exemption - Use Starting May 1, 2022
• M40-107A (11/02) - Time On Aid (no previous NOa issued), Other - Use Until April 30, 2022
• M40-107A (4/21) - Time On Aid (no previous NOa issued), Other - Use Starting May 1, 2022
• M40-107B (6/11) - Time On Aid at Redetermination - Use Until April 30, 2022
• M40-107B (4/21) - Time On Aid at Redetermination - Use Starting May 1, 2022
• M40-107C (10/19) - Time On Aid Between 42th and 46th Month
• M40-107C1 (9/20) - Time on Aid Between 54th and 57th Month - Use Starting May 1, 2022
• M40-107D (10/19) - Time On Aid To Former CalWORKs Recipients - Use Until April 30, 2022 
• M40-107D (4/21) - Time On Aid To Former CalWORKs Recipients - Use Starting May 1, 2022
• M40-107E (4/04) - 60th Month On Aid, Change
• M40-107F (6/11) - Extended Beyond 48 Months of Aid - Use Until April 30, 2022
• M40-107F (4/21) - Extended Beyond 60 Months of Aid - Use Starting May 1, 2022
• M40-107F1 (6/11) - Extender Met After 48th Month - Use Until April 30, 2022
• M40-107F1 (4/21) - Extender Met After 60th Month - Use Starting May 1, 2022
• M40-107F2 (6/11) - Extender Ended - Use Until April 30, 2022
• M40-107F2 (4/21) - Extender Ended - Use Starting May 1, 2022
• M40-107G (6/18) - 48th Month On Aid, Discontinue - Use Until April 30, 2022
• M40-107G (1/22) - 60th Month On Aid, Discontinue - Use Starting May 1, 2022
• M40-107H (11/02) - 60th Month On Aid - MFG child only, Change
• M40-107I (7/22) - 60th Month On Aid, No eligible child, Discontinue
• M40-107J (11/02) - Timed-Out Adult, Partial Approval - Use Until April 30, 2022
• M40-107J (4/21) - Timed-Out Adult, Partial Approval - Use Starting May 1, 2022
• M40-107J1 (6/11) - Approval After 48 Months on Aid - Use Until April 30, 2022
• M40-107J1 (4/21) - Approval After 60 Months on Aid - Use Starting May 1, 2022
• M40-107K (6/11) - Increase Grant due to TOA Adjustment - Use Until April 30, 2022
• M40-107K (4/21) - Increase Grant due to TOA Adjustment - Use Starting May 1, 2022
• M40-118A (8/96) - Incomplete Statement of Facts Form for Mandatory AU Members, Deny
• M40-118D (1/02) - Mandatory Filing Unit Members on Statement of Facts, Discontinue
• M40-125A (9/00) - Restore After a CW7/CW7Q Discontinuance, Approve
• M40-125B SAR (4/16) - Restore After a SAR7 Discontinuance
• M40-125C SAR (4/16) - Incomplete Semi-Annual Report (SAR7) Denial of Restoration
• M40-129B (11/09) - Full Payment - Approve
• M40-129B1 (12/90) - Approval after Immediate Need Payment, Approve
• M40-129C (12/90) - Miscellaneous, Deny
• M40-129C1 (12/90) - Received Aid Payment, Deny
• M40-129D1 (11/14) - Procedural Requirements, Deny
• M40-129D2 (12/90) - Procedural Requirements, Deny
• M40-129D3 (12/90) - Procedural Requirements, Deny
• M40-129D4 (9/00) - Procedural Requirements, Deny
• M40-129D5 (11/14) - Failed to Provide Proof of SSN Application, Deny  
• M40-129E1 (12/90) - No Emergency, Deny
• M40-129E2 (12/90) - No Emergency, Deny
• M40-129E4 (12/90) - No Emergency, Deny
• M40-129E5 (12/90) - No Emergency, Deny
• M40-129E6 (12/90) - No Emergency, Deny
• M40-157A1 (5/91) - Incomplete Citizen/Alien Documentation, Approve
• M40-157A4 (1/02) - Incomplete Citizenship/Noncitizenship Documentation, Discontinue
• M40-171A (11/14) - Failure to Cooperate, Deny
• M40-171B (5/91) - Refusal to Cooperate, Deny
• M40-171C (6/98) - Basic Approval
• M40-171D (6/18) - Basic Approval
• M40-171D SAR (5/16) - Late SAR7/Restoration
• M40-171M (7/87) - Not a California Resident, Deny
• M40-181 (9/13) - SAWS 2 Redetermination Of Eligibility
• M40-181A (11/14) - SAWS 2 Redetermination/Other Essential Information
• M40-181C (4/87) - Balderas Reminder Notice
• M40-181C SAR (9/13) - Notice Of Action - Balderas Reminder Notice
• M40-181D (5/91) - No Completed Monthly Report at Restoration, Deny
• M40-181E (11/14) - SAWS 2 PLUS Redetermination Immunizations/School Attendance, Change 
• M40-181F (7/22) - No Change at Redetermination
• M40-181G (10/23) - Redetermination Reminder Notice
• M40-195A (8/22) - ICT Notice Of Transfer, Sending
• M40-195B (8/22) - ICT Notice Of Transfer, Receiving
• M41-401A (12/86) - No Deprivation, Deny
• M41-440F (6/98) - 100 Hour Work Rule, Deny
• M41-440G (5/20) - 100 Hour Work Rule
• M41-450A (1/98) - Absent Parent in Uniformed Services, Deny
• M42-101B (11/14) - Age and School Requirements
• M42-101C (11/14) - Age and School Requirements, Discontinue
• M42-207A (10/15) - Over Property Limit, Deny
• M42-213F (1/02) - Property Not Sold, Discontinue
• M42-221J (1/02) - Transfer w/out Fair Consideration, Discontinue
• M42-221K (7/98) - Transfer w/out Fair Consideration, Suspend
• M42-221L (4/00) - Transfer w/out Fair Consideration, Suspend
• M42-221M (1/02) - Transfer w/out Fair Consideration, Discontinue
• M42-431A4 (11/14) - No Eligible Noncitizen Status/Proof of Eligible Noncitizen Status, Discontinue  
• M42-769A (11/14) - Apply $100 Cal-Learn Penalty
• M42-769C (9/94) - Stop Cal-Learn Penalty
• M43-107C (1/98) - Cooperate, Change
• M43-119C (1/02) - Needs Met, Discontinue
• M43-119E (1/98) - Some Members Needs Met, Change
• M43-119G (11/14) - Missing SAR 72, Change
• M43-119H (11/14) - Missing SAR 72, Discontinue
• M43-119I (7/98) - Deemed Sponsor's Property and Family Property, Change
• M43-119J (7/98) - Deemed Sponsor's Property, Change
• M43-119K (7/98) - Deemed Sponsor's Property and Family Property, Deny
• M43-119L (7/98) - Deemed Sponsor's Property, Deny
• M43-119M (1/98) - Deemed Sponsor's Income, Change
• M43-119O (1/02) - Deemed Sponsor's Property and Family Property, Discontinue
• M43-119P (1/02) - Deemed Sponsor's Property, Discontinue
• M44-113A (6/98) - Disallowance of Deductions, Change
• M44-113G1 (6/98) - Change in Income
• M44-113H (11/12) - Change In Income
• M44-129E1 (12/90) - No Emergency, Deny
• M44-133D (6/98) - 18 Year Old, End of Deeming, Change
• M44-133Q (6/98) - Minor Parent Income, Change
• M44-133S (6/98) - Minor Parent, Financial Eligibility, Change
• M44-133S (5/20) - Minor Parent, Financial Eligibility, Change
• M44-133T (9/20) - Minor Parent, Financial Eligibility, Partial Approval
• M44-207I SAR (4/16) - Financial Eligibility
• M44-207J (6/98) - Financial Eligibility, Deny
• M44-207K (1/02) - Financial Eligibility, Discontinue - Use Until May 31, 2020
• M44-207K (5/20) – Financial Eligibility, Discontinue – Use Starting June 1, 2020
• M44-207K1 (5/20) - Minor Parent, Financial Eligibility
• M44-207L (6/98) - Financial Eligibility Test, Suspend
• M44-207M (8/20) - Financial Eligibility, Deny
• M44-211A (12/19) - Temporary Shelter and Permanent Housing, Approve
• M44-211B (10/21) - Expanded Temporary HA For Applicants Fleeing DV, Approve
• M44-211D (9/23) - Temporary Shelter And/Or Permanent Housing
• M44-211L (9/23) - Pregnancy Special Needs, Approve
• M44-211N (9/23) -  Pregnancy Special Needs, Change 
• M44-211O (9/23) - Discontinue Pregnancy Special Needs Payment for Pregnant Person Only Assistance Unit
• M44-305 (9/97) - Change of Payee, Other
• M44-307A (11/15) - Voucher/Vendor Payment, Other
• M44-307B (1/99) - Voucher/Vendor Payment, Change
• M44-307C (7/98) - Voucher/Vendor Payment, Change       
• M44-315A (5/20) - $10 Minimum Payment, Change - Use Until April 30, 2022
• M44-315A (8/21) - $10 Minimum Payment, Change - Use Starting May 1, 2022
• M44-315B (9/98) - ICT between Reg-1 and Reg-2 MAP Increase/Decrease, Change
• M44-315C (4/09) - Notice of Action - Four Percent Grant Reduction
• M44-316A (5/20) - Notice Of Action - Not Yet Changed 
• M44-316B (9/13) - Notice Of Action - Change In Income Over IRT   
• M44-316C (8/22) - Notice Of Action - No Change/Mid-Period Report Of Property
• M44-316 SAR (9/13) - No Change/Mid-Period Reporting
• M44-316C SAR (10/17) - No Change/Mid-Period Report of Property
• M44-316D SAR (9/13) - Notice Of Action - Change In Income
• M44-316E (10/16) - Mid-Period Change Due To The Death Of A Child
• M44-340 (2/23) - Underpayment Adjustment, Approval
• M44-340B (9/07) - Underpayment Adjustment 
• M44-340C (8/12) - Underpayment Adjustment
• M44-350A (11/11) - Overpayment Adjustment
• M44-350E (11/11) - Excess Property O/P and Adjustment (W/O Good Faith)
• M44-350F (11/11) - Excess Prop O/P (W/O Good Faith)
• M44-350G (11/11) - Excess Prop O/P Adjustment (With Good Faith)
• M44-350H (11/11) - Excess Prop O/P (With Good Faith)
• M44-350ISAR (9/13) - Notice Of Overpayment
• M44-350K (6/24) - EBT Replacement Denial
• M44-350L (12/18) - Notice Of Overpayment
• M44-350M (10/19) - Suspension Of Overpayment 
• M44-350N (10/19) - Suspend Overpayment Recovery
• M44-352A (11/11) - Notice of O/P and Demand
• M44-352C (11/11) - Overpayment Recovery
• M44-352D (11/11) - Overpayment Recovery
• M44-352G (11/11) - Demand Overpayment
• M44-352H (2/23) - Overpayment Adjustment 
• M44-353 (2/24) - Notice Of Overpayment Discharge
• M44-401A (6/98) - Reduced Income Supplemental Payment, Approve
• M44-401B (6/98) - Reduced Income Supplemental Payment, Deny
• M81-215A (6/98) - Diversion Payment Provided, Deny
• M81-215B (6/98) - Diversion Services Provided, Deny
• M81-215D (6/98) - Diversion Repayment Stops, Change
• M81-215E (6/11) - Time Limit Diversion - Use Until April 30, 2022
• M81-215E (4/21) - Time Limit Diversion - Use Starting May 1, 2022
• M81-215F (6/11) - Time Limit Diversion - Use Until April 30, 2022
• M81-215F (4/21) - Time Limit Diversion - Use Starting May 1, 2022
• M82-506 (6/98) - Failure to Cooperate, Change
• M82-506a (6/98) - Failure to Cooperate, Partial Approval
• M82-510 (6/02) - Failure to Cooperate, Change
• M82-510A (6/98) - Cooperate, Change
• M82-812 (4/04) - Family Reunification/Zero Grant 
• M82-812A (6/24) - Start of Cash Aid for Family Reunification Case
• M82-812B (6/24) - End of Cash Aid Following Family Reunification Discontinuance - Child Returned to Home
• M82-812C (11/24) -  Family Reunification - End of Cash Aid 
• M82-820A (9/21) - No Eligible Person, Deny
• M82-820B (1/02) - Application for Mandatory, AU Members, Discontinue
• M82-820C (1/02) - Eligible Child Left Home, Discontinue
• M82-820D (9/23) - No Longer Eligible, Discontinue
• M82-832A (2/99) - Fleeing Felons, Change
• M82-832B (2/99) - Fleeing Felons, Partial Approval   
• M82-832E (4/15) - Eligible Person Leaving AU, Change
• M82-832F (4/15) - Eligible Person Leaving AU, Discontinue
• M82-832G (6/18) - Eligible/Mandatory/Optional Person Leaving AU
• M82-832H (10/20) - Child Does Not Meet Requirements (SB 380)
• M82-836A (8/91) - Unborn not eligible for aid, Deny
• M89-110 (1/98) - Exemptions to MAP Reductions, Change - Exempt
• M89-110A (1/98) - Exemptions to MAP Reductions, Change - Non-exempt
• M89-110B (1/98) - Exemptions to MAP Reductions, Deny
• M89-130 (1/02) - Restricted Account, Discontinue
• M89-201 (11/96) - No Appropriate Living, Deny
• M89-201A (11/99) - No Appropriate Living Arrangement or Allowable Exemption, Discontinue
• MT42-101.2D (11/04) - Fry v. Saenz Lawsuit, Age Requirement, Change
• MT42-101.2E (11/04) - Fry v. Saenz Lawsuit, Age Requirement, Discontinue
• TEMP 44-111A (4/13) - Income Disregards Change
• TEMP M40-107A (9/11) - CalWORKs 48-Month Time Limit Time On Aid (Unticking Months Due To Temporary Exemptions)
• TEMP M40-107E (4/11) - Change CalWORKs Time Limit 48th Month On Aid
• TEMP M40-107G (4/11) - Discontinue CalWORKs Time Limit/Income Exceeds
• TEMP M40-107H (4/11) - Change CalWORKs Time Limt 40th Month On Aid-MFG Child
• TEMP M40-107I (4/11) - Discontinue CalWORKs Time Limit 48th Month On aid, No Eligible Child
• TEMP M40-107J (4/11) - Partial Approval CalWORKs Time Limit Timed-Out Adult   
• TM44-314 (8/16) - Basic Approval
• TM44-315D (4/11) - 8 Percent Grant Reduction Change
• TM44-315E (4/11) - Grant Reduction And Income Disregard Discontinue
• TM44-315F (4/11) - Grant Reduction And Income
• TM44-315G (12/13) - Law Change To MAP Levels
• TM44-315H (9/14) - Law Change To MAP Levels
• TM44-315I (8/16) - Law Change To MAP Levels
• TM44-315J (9/18) - Law Change To MAP Levels
• TM44-315K (7/19) - Law Change To MAP Levels
• TM44-315L (7/21) - Law Change To MAP Levels
• TM44-315M (7/22) - Law Change To MAP Levels
• TM44-315N (7/23) - Law Change To MAP Levels
• TM44-315O (7/24) - Law Change to MAP Levels
• TM82-832 (12/14) - Basic Approval
• WI 10072A (10/23) - EBT Replacement Approval
• WI 10072B (10/23) - EBT Replacement Review